三种支架用于经颈静脉肝内门体静脉分流术的安全性及疗效分析

Safety and clinical efficacy of three types stents of transjugular intrahepatic porto-systemic shunt in treatment of cirrhosis with portal hypertension

目的探讨不同支架在经颈静脉肝内门体静脉分流(TIPS)术治疗肝硬化门静脉高压中的安全性、有效性。方法收集因肝硬化门静脉高压在我院初次接受TIPS的患者1 086例,将患者分为裸支架组(A组)、覆膜支架组(B组)和双支架组(C组),分析并比较3组患者术后2年内分流道失效率、术后再出血发生率、总生存率及主要并发症发生率。结果 1 086例患者共置入支架1 690枚,TIPS术技术成功率为100%。2.53%(10/396)的急诊患者在围手术期因不可控的上消化道出血死亡;2.78%(11/396)的急诊患者因急性肝功能衰竭死亡,0.84%(5/593)出血停止期患者因急性肝功能衰竭死亡。A、B、C组患者2年总生存率分别为83.78%(186/222)、88.36%(281/318)、96.34%(526/546),差异有统计学意义(χ2=4.15,P=0.04)。A、B、C组分流道失效率分别为39.64%(88/222)、22.33%(71/318)、11.17%(61/546),差异有统计学意义(χ2=4.15,P=0.04)。A、B、C组TIPS术后再出血率分别为31.53%(70/222)、16.89%(54/318)、7.14%(39/546),差异有统计学意义(χ2=9.91,P=0.01);A、B、C组肝性脑病发生率分别为21.62%(48/222)、22.96%(73/318)、19.23%(105/546),差异无统计学意义(χ2=1.00,P=0.06)。结论 TIPS术可有效缓解患者门静脉高压及其并发症,选择直径8mm分流通道,并采用双支架技术可提高TIPS治疗的安全性、有效性。

Objective To analyze the safety and clinical efficacy of three types stents of transjugular intrahepatic porto-systemic shunt （TIPS） in treatment of cirrhosis with portal hypertension. Methods Totally 1 086 patients with cirrhotic portal hypertension underwent TIPS for the first time. All patients were divided into bare stent group （group A）, covered stent-group （group B） and combined stents group （group C）. The rates of symptom improvement, shunt insufficiency, rebleeding, survival and major complications in 2 years after TIPS were analyzed and compared. Results Totally 1 690 stents were placed in 1 086 patients. The overall technical success rate was 100%; 2.53% （10/396） emergency patients dead due to uncontrolled gastrointestinal bleeding, and 2.78% （11/396） emergency patients, 0.84% （5/593） bleeding stopped patients dead with acute liver funtional failure. In 2-year following-up, the overall survival rate of group A, group B, group C were 83.78% （186/222）, 88.36% （281/318）, 96.34% （526/546）, and the difference was statistical significant （χ^2=4.15, P=0.04）. The shunt insufficiency rates of group A, group B, group C were 39.64% （88/222）, 22.33% （71/318）, 11.17% （61/546）, and the difference was statistical significant （χ^2=4.15, P=0.04）, The rates of rebleeding of group A, group B, group C were 31.53% （70/222）, 16.89% （54/318）, 7.14% （39/546）, and the difference was statistical significant （χ^2=9.91, P=0.01）. The rates of hepatic encephalopathy of group A, group B, group C were 21.62% （48/222）, 22.96% （73/318）, 19.23% （105/546）, and the difference had no statistical significant （χ^2=1.00, P=0.06）. Conclusion TIPS is an effective way to relieve portal hypertension and complications in patients with cirrhosis. The safety and clinical efficacy can be improved by 8 mm shunt with double stent technique.